GER vs. GERD: When is spitting-up a concern?

Burp cloths are a must-have item for every expectant parent for a good reason. Babies are messy! It can be a bit of a shock anytime your baby eats and then spits up a portion of what she’s eaten. Fortunately—especially during the first year of life—these incidents are more of a nuisance than a medical problem.

What is GER? 

The medical diagnosis for “spitting up” is gastroesophageal reflux (GER). GER commonly occurs when babies (especially newborns) consume more than their stomachs can comfortably hold. Thankfully, GER decreases with age, but it may not fully resolve until your baby’s first birthday. Some babies will continue to spit up until age 2.

What are strategies for managing GER? 

Most children will outgrow GER. But, in the meantime, here are strategies that may keep your baby from spitting up: 

  • Avoid overfeeding. Consider giving smaller feedings more frequently. Breastfeed well on a single breast before offering the second breast. A single breast can usually provide a full meal. (Read here to learn more about signs that show your baby is getting enough to eat.)Watch your baby for signs that she is full, such as releasing the breast, stopping sucking, or turning away from the breast. Bottle-fed babies will display the same cues, but parents often ignore signs of fullness and feed until the bottle is empty.
  •  Pay attention to positioning. Holding your baby upright, or partially upright, during feedings allows gravity to help keep stomach contents down and prevent regurgitation. (Learn about breastfeeding positions here.) Keeping your baby upright for 30 minutes after a feeding can also help.
  •  Burp your baby frequently. Burp breastfed babies when switching from the first breast to the second and again at the end of the feeding. Formula-fed babies can be burped midway through the feeding and again at the end. In addition, bottle-fed babies should be given a chance to pause throughout the feeding to rest and breathe.
  •  Minimize the amount of air your baby swallows. Keep your baby’s head aligned with the rest of his body to ease swallowing. If breastfeeding in a cradle or cross-cradle position, your baby should be tummy-to-tummy. If you are bottle-feeding, be sure milk (and not air) fills the nipple.
  •  Reassure your baby. Less agitated babies are less likely to spit up. Rhythmic walking, patting, singing, or “shushing" may help to soothe your baby.
  • Have your baby sleep on her back. Like all babies, those with GER should sleep on their backs. In rare cases, your baby’s healthcare provider may suggest an alternative sleep position.
  • Speak with an expert. Talk with your baby’s doctor, nurse, or lactation consultant about how much breast milk or formula your baby needs.

What is GERD? 

Parents should distinguish between GER and GERD, which is gastroesophageal reflux disease. GERD is a more serious and long-lasting form of GER in which acid reflux irritates the esophagus. A small number of babies develop severe symptoms typical of GERD. These include:

  • poor growth due to an inability to hold down enough food 
  • irritability or refusing to feed because of pain 
  • blood loss from acid burning the esophagus 
  • breathing problems

How is GERD treated? 

Some experts believe that GERD is overdiagnosed and overtreated because of the availability and marketing of prescription medications. Therefore, such medications should be used sparingly in babies, given concerns related to overuse. If your child is diagnosed with GERD, talk with your doctor about alternate strategies, such as cereal-thickened feedings or antacids, rather than prescription medications. 

How is spitting up different from vomiting? 

Another form of regurgitation is vomiting, described as “the forceful throwing up of stomach contents through the mouth.” In young infants, this reflex is generally triggered by irritation or swelling of the gastrointestinal tract (as from an infection or blockage). An ear infection or motion sickness can also cause vomiting.

If your baby has other signs of illness besides vomiting (fever, irritability, or fatigue), you should contact your baby’s healthcare provider immediately.

Last updated December 6, 2021

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